National Provider Identifier Database

DEACONESS ILLINOIS CROSSROADS INC
Radiology


Contact Information

DEACONESS ILLINOIS CROSSROADS INC
4119 S WATER TOWER PL STE A
MOUNT VERNON, IL62864-6293
Phone: 618-246-9595
Fax:
Website:
Specialty Taxonomy Code
* Radiology 261QR0200X

* Indicates primary specialty

NPI Profile & details for DEACONESS ILLINOIS CROSSROADS INC

NPI Number 1548986839
Legal business name
LBN
DEACONESS ILLINOIS CROSSROADS INC
Authorized official JARED STIMPSON - (TREASURER)
Entity Organization
Organization subpart No
Enumeration date 10/18/2022
Last updated 01/11/2023 - About 3 years ago
Sole proprietor1 Not specified
Identifiers n/a

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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